How a Rural HIE Boosted its Public Health Reporting, Data Exchange

The healthcare industry was flipped upside down during 2020 due to the COVID-19 pandemic. Patient data exchange and public health reporting were issues before the pandemic, and these two areas of health IT were magnified over the last 11 months.

Hospital overcrowding pushed patients into facilities they otherwise might not have visited, increasing the potential a provider might not have access to a full medical history. A strong patient data exchange has proven key to mitigating that problem.

“One of the things that really came out of 2020, and especially with the COVID pandemic, was the importance of streamlining electronic processes for data collection and sharing,” Shila Blend, director of North Dakota Health Information Network, said to EHRIntelligence.

North Dakota public health labs utilize syndromic surveillance to detect the early signs of an outbreak. However, syndromic surveillance systems leverage existing real-time patient data to provide immediate analysis and feedback. The state’s paper form process couldn’t keep up with the COVID-19 outbreak.

“When COVID hit, providers weren't necessarily ready for the surge of testing and reporting with paper forms,” Blend said. “With paper forms, providers in the state were doing thousands and thousands of tests a day. That's a large number of paper forms.”

Efficiency is a key component for all HIEs and especially in the rural state of North Dakota. 

HIEs connect communities and ensure patient health records are available at all times. But in North Dakota, not all hospitals and providers can participate in HIEs because rural hospitals and providers do not have the same capital as larger hospitals.

“We've been working for years with our state health lab to minimize paper forms and really use our HIE to help collect data for the mandated public health reporting that goes into our health information system,” Blend explained. “That data includes electronic lab reporting, syndromic surveillance, immunization data with a bi-directional query to providers' EHR, and electronic test and order results to the North Dakota State Public Health Lab.”

Luckily for NDHIN, some of these pieces were in place prior to the pandemic, but Blend and her team saw the benefits throughout 2020.

“What we found over the years, even prior to COVID-19, is that it takes a lot of paperwork that providers used to have to do by hand and fax or manually send to public health organizations,” Blend continued. “Automating that process allows North Dakota providers more patient care time, more time to do other things, and interact with their patients instead of worrying about paper forms.”

NDHIN and North Dakota Information Technology, the state agency that NDHIN is a part of, worked closely with the state’s department of health to create an electronic test registry and management system to reduce the number of paper forms.

“That really helped with streamlining COVID efforts across our state,” Blend added.

But then Blend and her team were confronted by another problem: providers across the state were manually calling individuals and checking up on them once or twice a day to collect information.

This burdensome process needed to be streamlined electronically.

“While working through finding electronic means to improve this, we realized we could leverage our current ADTs and our alerts to have state health lab officials who were monitoring these individuals notified if any of them hit a hospital,” Blend explained. “That was really beneficial for them to get alerts if there was all of a sudden that change in status, and that helped streamline the situation.”

But once the spread eventually subsides, Blend said NDHIN will continue to optimize and utilize these alerts and notifications to keep providers updated on their respective patient statuses.

“North Dakota is a very rural state and often individuals may see their primary provider in a rural area, but if they have a sudden health episode, they're admitted to a hospital in another city that's further away from their primary,” Blend continued. “ADTs and alerts and notifications are going to be very important with care coordination moving forth as we go into the future with them.”

Moving forward, NDHIN is focused on adding more providers, and specifically larger providers, to continuously expand its network.

“The partners and participants are the most important part of this because as the rules and guidelines are changing, especially through COVID, we can work to find ways that we can work with them and help them,” Blend concluded. “We've also been working on getting the additional larger hospitals in our state on electronic lab ordering and reporting, and that was another way that we could minimize the paper process and help streamline the processes in ordering and reporting of lab results.”